Technology may be an increasing part of healthcare but pharmacists need to consider both its benefits and risks and what’s right for their businesses, reports Kathy Oxtoby…

Whether embracing its benefits or cautious of its risks, there’s a growing awareness within the pharmacy profession that technology will feature increasingly in healthcare.

A risk-free route?

“Automation, robotics, and other technological advances in pharmacy – for example, electronic prescriptions, electronic pharmacy service management, shared health records and artificial intelligence for clinical decision making – have great potential to improve health outcomes for citizens, and also to enhance the professionalism of, and professional services provided by, pharmacy professionals,” says Stephen Goundrey-Smith, a member of the RPS Digital Pharmacy Expert Advisory Group (DPEAG).

However, they are “by no means without risk”, he says. For example, “fragmentation of data within electronic systems, and the way data are displayed to human decision-makers, can introduce clinical risk”.

Ade Williams, lead pharmacist at Bedminster Pharmacy in Bristol, says that as well as benefiting from the freedom that can come from using technology such as automated dispensing, it is also important for pharmacists to consider safeguarding and quality issues.

Automation, robotics, and the advance of technology in the sector is a route Graham Phillips, “is in favour of”, but from experience he has found that it’s “not risk free”. In 2022, the superintendent pharmacist of Manor Pharmacy Group in Letchworth, invested almost £200,000 in  integrating his Patient Medication Record (PMR) system with a bespoke dispensing robot and two automated prescription collection points. But since “day one” he has found the different systems “don’t ‘talk’ to each other, and don’t work properly”.

“If you’re a busy pharmacy and all the technology works, it provides a better service. But if none of those things apply, it means you’ve spent a huge amount of money on systems, that can never be recouped,” he says. “But that doesn’t mean I’m anti-automation. It’s definitely the way forward.”

Fin McCaul, an independent pharmacist at Prestwich Pharmacy, Manchester, and committee member of Community Pharmacy England, says each pharmacy needs to look at their own situation to understand what new developments may help them. “For some, it may be automation and robotics, for others, investing in a new Patient Medical Record (PMR) system. Perhaps even both, although this can be a big change for staff and how they work. The risks can be complex and all elements and avenues must be explored,” he says.

Latest innovations

One of the latest areas of technology innovation for community pharmacy is the development of pharmacy ‘platform management’ systems for end-to-end customer management, such as Charac, says Mr Goundrey-Smith.

Some PRM systems are exploring the use of artificial intelligence to support professional decision support – for example, the Invatech Titan system, he says.

Service support systems from providers, such as Sonar Informatics and PharmOutcomes will “continue to be important for supporting existing pharmacy services, and enabling pharmacists to provide proposed new services”, he says.

While pharmacy robots are “well-established” in hospitals, he says “there is still a push for robotics adoption in community pharmacies, with many robot suppliers still competing for the community pharmacy market”.

Dispensing robots, and hub and spoke models

A potential future consideration for independent pharmacists will be whether to install a dispensing robot, or to enter into a hub and spoke model. Mr Goundrey-Smith says that legislative changes to enable a hub and spoke dispensing model have not yet taken place [https://www.gov.uk/government/consultations/hub-and-spoke-dispensing], but pharmacy robots are available now, so could be installed in a high-volume pharmacy “with a view to it becoming a dispensing hub in future”.

The risk of entering into a hub and spoke arrangement is that “the role of the local pharmacy - the ‘spoke’ - is downgraded, patient safety is compromised, and relationships with patients are affected”, he says. “However, these risks may be mitigated depending on how the pharmacy implements its systems.”

Gareth Jones, National Pharmacy Association (NPA) director of corporate affairs, says that historically “the business case for utilising hub and spoke in most pharmacies has not been strong, but that could change as technology develops, and with more NHS funding for clinical services delivered from community pharmacies".

Mr Fin says each pharmacy will need to consider who owns the data, what is the price guarantee on the product element, is there a risk of losing margin, and how long will it take for the product to deliver back to the pharmacy the benefit, considering the upfront and ongoing cost.

Benefits involved in entering into a hub and spoke arrangement are expected to include reduced staff time on dispensing at the spoke pharmacy - freeing up time to provide other services - and potential for reduced rates of dispensing errors, says Mr Fin.

However, risks include that the costs and benefits of different hub and spoke arrangements may result in different costs and benefits falling on different affected parties, he says.

Lila Thakerar, superintendent pharmacist at Shaftesbury Pharmacy in Harrow, says her patients like face-to-face support with their prescriptions, so a hub and spoke model would mean “a break in communication between patient and pharmacist”. And for Ms Thakerar, ensuring patient safety “has to be through personalised supervision and accuracy checking, rather than relying on robotic technology”.

Interoperability and community pharmacy

The current level of interoperability of community pharmacy IT with the IT in general practice and hospitals is “ready for modernisation”, says David Broome, a member of the Community Pharmacy England committee and Community Pharmacy IT Group vice chair, and an independent pharmacist at Stancliffe Pharmacy, Leeds. The current model “leads to inefficiencies within the end-to-end system and unnecessary levels of administrative burden”, he says.

Community Pharmacy England “welcomes the NHS England digital roadmap as described in the delivery plan for recovering access to primary care”, he says. The plan to implement GP Connect [https://digital.nhs.uk/services/gp-connect]and the Booking and Referral Standard (BaRS) [https://digital.nhs.uk/services/booking-and-referral-standard] into community pharmacy systems offers “significant improvement to enable efficient clinical communication for community pharmacy with the wider health system”, he says.

“We hope this is the starting point, and that the ambition of the NHS Digital Services for Integrated Care [https://digital.nhs.uk/services/digital-services-for-integrated-care] pharmacy IT workstream is expanded,” he says.

Don’t rush, and do your homework

When considering adopting any technology in the pharmacy “don’t rush into any decisions”, says Ms Thakerar. “Make sure you have considered patient safety, and cost implications, and that your business model is set up, before launching into any major IT innovation”.

It’s important to “do your homework”, advises Mr Williams. “Read up on IT and visit others who have adopted particular ways of working with technology”, he says. And it’s important when investing in technology that it is “adaptable, has longevity and is upgradable”.

“Don’t fall for marketing blurb,” says Mr Phillips. “Speak to colleagues who have experience of the systems, and find out whether they deliver in practice the promises made by the marketing.”

And Mr Jones says while it’s right to explore how certain processes can be automated to free up time for patient facing care, “we mustn’t bypass the professional input of pharmacists, always remembering that medicines have the power to harm as well as to heal”.

Information/resources

• Community Pharmacy IT Group (CP ITG): https://cpe.org.uk/cpitg
• Department of Health and Social Care: Hub and Spoke Dispensing. (Closed consultation) https://www.gov.uk/government/consultations/hub-and-spoke-dispensing
• NHS Digital: GP Connect. https://digital.nhs.uk/services/gp-connect
• NHS Digital: The Booking and Referral Standard (BaRS). https://digital.nhs.uk/services/booking-and-referral-standard
• NHS Digital: Digital Services for Integrated Care. https://digital.nhs.uk/services/digital-services-for-integrated-care